不同身份參與羊水栓塞原位情景模擬教學(xué)的效果及運用

肖靜　周志強　曹雪芹　錢巍　張志發(fā)　羅放

[摘要] 目的 探討在原位模擬教學(xué)中以不同身份參與教學(xué)的麻醉醫(yī)生對圍術(shù)期羊水栓塞的識別和處理能力及效果。方法 于2019年3月在我院參加麻醉科住院醫(yī)師規(guī)范化培訓(xùn)的二年級、三年級住院醫(yī)師，以及進修醫(yī)生中招募29名學(xué)員參加模擬教學(xué)，綜合教學(xué)前理論考核成績和個人意愿分組分工，其中病例操作組12人，觀察評價組17人。病例操作組學(xué)員參加Simman 3G模擬人的羊水栓塞原位情景模擬病例運行，觀察評價組學(xué)員作為觀察者對操作組學(xué)員團隊的操作對照教學(xué)目標(biāo)評價表進行評價。比較兩組操作前理論考核成績、教學(xué)滿意度反饋評價、模擬教學(xué)效果反饋評價、學(xué)習(xí)后理論知識復(fù)測成績。 結(jié)果 以不同身份體驗開展模擬教學(xué)，兩組學(xué)員在教學(xué)后理論成績均明顯高于教學(xué)前，差異有統(tǒng)計學(xué)意義（P<0.05），但組間差異無統(tǒng)計學(xué)意義。100.0%的學(xué)員對原位情景模擬教學(xué)表示滿意，對教學(xué)方法表示認(rèn)可;96.3%的學(xué)員認(rèn)為該教學(xué)方法達到或超過預(yù)期效果;100.0%的學(xué)員認(rèn)為該教學(xué)方法可以加深理論知識和處理流程的掌握、提高處理突發(fā)事件的溝通能力和團隊合作能力。 結(jié)論 原位情景模擬羊水栓塞的教學(xué)方法是一種可行、有效的教學(xué)方法，觀察評價者同樣能夠通過直觀地感受病例、分析病例，參與教學(xué)評價，收獲很好的教學(xué)效果。

[關(guān)鍵詞] 原位情景模擬教學(xué);羊水栓塞;不同身份參與;Simman 3G

[中圖分類號] G642;R47-4 ? ? ? ? ?[文獻標(biāo)識碼] B ? ? ? ? ?[文章編號] 1673-9701（2020）30-0009-05

Effects and applications of in-situ scenario simulation teaching of amniotic fluid embolism participates with different identities

XIAO Jing ? ZHOU Zhiqiang ? CAO Xueqin ? QIAN Wei ? ZHANG Zhifa ? LUO Fang

Department of Anesthesiology， Tongji Hospital， Tongji Medical College of Hust Tongji Medical College Huazhong University of Science & Technology， Wuhan ? 430030， China

[Abstract] Objective To investigate the recognitions， treatment abilities and effects of anesthesiologists who participated in in-situ scenario simulation teaching of perioperative amniotic fluid embolism with different identities. Methods In March 2019， a total of 29 students were recruited from the second-year and third-year residents and refresher doctors who participated in the standardized training of anesthesiology residents admitted to our hospital to participate in the simulation teaching， and the theoretical assessment scores and personal wishes before the teaching were divided into the case operators group（n=12） and the observation evaluators group（n=17）. Students in the case operators group were organized to participate in Simman 3G simulated amniotic fluid embolism in-situ scenario simulation case operation. Students in observation evaluators group， as observers， were organized to evaluate the operation control teaching objective evaluation table of students in the case operators group. The scores of theoretical examinations before operation， feedback evaluation of teaching satisfaction， feedback evaluation of simulated teaching effect and retest scores of theoretical knowledge after learning were compared between the two groups. Results With different identity experiences， the theoretical scores of the two groups were obviously higher than those before teaching， and the difference was statistically significant（P<0.05）， but there was no difference between the two groups. 100.0% of the students were satisfied with the in-situ scenario simulation teaching and the teaching method was approved. 96.3% of the students thought that the teaching method achieved or exceeded the expected effect. 100.0% of the students thought that this teaching method could deepen the mastery of theoretical knowledge and processing flow， and improve the communication ability and teamwork ability in dealing with emergencies. Conclusion In-situ scenario simulation of amniotic fluid embolism is a feasible and effective teaching method， and observers and evaluators also feel cases intuitively， analyze cases， participate in teaching evaluation， and gain good teaching results.

[Key words] In-situ scenario simulation teaching; Amniotic fluid embolism; Participation with different identities; Simman 3G

羊水栓塞（Amniotic fluid embolism，AFE）是妊娠期特有的罕見并發(fā)癥，可以導(dǎo)致母兒死亡等災(zāi)難性后果，其發(fā)病率為（1.9～6.1）/10萬，死亡率可達19%～86%[1]。麻醉科作為急危重癥患者搶救的平臺科室，是急危重癥產(chǎn)婦搶救醫(yī)療團隊的重要一員。由于羊水栓塞病例散發(fā)、少發(fā)，臨床醫(yī)生很難通過實踐積累足夠豐富的經(jīng)驗來應(yīng)對[2]，麻醉醫(yī)生更難積累足夠經(jīng)驗。然而，臨床工作要求麻醉醫(yī)生必須熟知這類罕見并發(fā)癥。臨床研究發(fā)現(xiàn)，有經(jīng)驗的麻醉醫(yī)生可能在改善羊水栓塞產(chǎn)婦預(yù)后中發(fā)揮重要作用[3]?！?br>